UMass Chan Medical School Faculty Publications


The CAM-S: development and validation of a new scoring system for delirium severity in 2 cohorts

UMMS Affiliation

Department of Medicine, Division of Geriatric Medicine; Meyers Primary Care Institute

Publication Date


Document Type



Activities of Daily Living; Aged; Aged, 80 and over; Cognition Disorders; Delirium; Female; Hospital Costs; Humans; Length of Stay; Male; Nursing Homes; *Psychological Tests; Psychometrics; Severity of Illness Index


Geriatrics | Health Services Research | Psychiatry and Psychology


BACKGROUND: Quantifying the severity of delirium is essential to advancing clinical care by improved understanding of delirium effect, prognosis, pathophysiology, and response to treatment.

OBJECTIVE: To develop and validate a new delirium severity measure (CAM-S) based on the Confusion Assessment Method.

DESIGN: Validation analysis in 2 independent cohorts.

SETTING: Three academic medical centers.

PATIENTS: The first cohort included 300 patients aged 70 years or older scheduled for major surgery. The second included 919 medical patients aged 70 years or older.

MEASUREMENTS: A 4-item short form and a 10-item long form were developed. Association of the maximum CAM-S score during hospitalization with hospital and posthospital outcomes related to delirium was evaluated.

RESULTS: Representative results included adjusted mean length of stay, which increased across levels of short-form severity from 6.5 days (95% CI, 6.2 to 6.9 days) to 12.7 days (CI, 11.2 to 14.3 days) (P for trend and < 0.001) and across levels of long-form severity from 5.6 days (CI, 5.1 to 6.1 days) to 11.9 days (CI, 10.8 to 12.9 days) (P for trend andlt; 0.001). Representative results for the composite outcome of adjusted relative risk of death or nursing home residence at 90 days increased progressively across levels of short-form severity from 1.0 (referent) to 2.5 (CI, 1.9 to 3.3) (P for trend andlt; 0.001) and across levels of long-form severity from 1.0 (referent) to 2.5 (CI, 1.6 to 3.7) (P for trend and < 0.001).

LIMITATION: Data on clinical outcomes were measured in an older data set limited to patients aged 70 years or older.

CONCLUSION: The CAM-S provides a new delirium severity measure with strong psychometric properties and strong associations with important clinical outcomes.

PRIMARY FUNDING SOURCE: National Institute on Aging.

DOI of Published Version



Ann Intern Med. 2014 Apr 15;160(8):526-33. doi: 10.7326/M13-1927. Link to article on publisher's site

Related Resources

Link to Article in PubMed

Journal/Book/Conference Title

Annals of internal medicine

PubMed ID